"Still, there’s often confusion about who is caring for the patient ... " Playing off of Jimmy the Greek's comment,…
Linda Reed is VP of integrative and behavioral medicine and CIO of Atlantic Health System of Morristown, NJ.
Tell me about yourself and your job.
I’m the vice president of integrative and behavioral medicine and chief information officer. I’ve been at Atlantic Health 10 years. For the first six, I was vice president and CIO.
About five and a half years ago, I got integrative medicine, which is massage, yoga, supplements, functional medicine, and acupuncture. Then about three years ago, I got behavioral health. One of my doctor friends here says, “Who did you annoy that you were able to get such a wide variety of things?” It’s funny because I tell the CFO here that I’m like the empress of everything that is expensive that makes no money. It’s interesting. My day is right brain, left brain.
I’m a nurse by background. I’ve been a CIO for almost 20 years. I just love what I do every day. I’m an activity junkie and this job really suits that.
How much of your IT effort is focused on plumbing type work like Meaningful Use and ICD-10?
I’d say it’s probably 60 or 65 percent.
We try really hard to do some other interesting things. We’ve put a lot of effort into mobile health. We’ve got a mobile health strategic plan. We just published a mobile health app. Taking a look at some interesting new and different kind of things to do with mobile health. We’re trying to spend a lot of time there doing a little more with telemedicine. There’s all this new, cool stuff you want to do, but you’re really anchored back in the ICD-10, Meaningful Use world.
We’re doing a lot of acquisition. We’ve added two hospitals in the last three and a half years and we’ve got one more coming at the end of December. They’re all different. One hospital was on a really old platform, not the one that we’re on, so we kind of ripped and replaced. The second one that we got had put some money into the platform that they’re on, so we decided to leave that one alone because they had attested. The third one that we’re getting is a little bit of both. They’ve got two different systems on the front and back end, so we’re still looking to see exactly how that one’s going to transition in. We just went live on Tuesday with a brand new ambulatory system for our physicians. It never stops.
Which ambulatory system did you go live on?
Are you still primarily a McKesson shop?
Yes, we’re still McKesson.
They’ve sent some mixed signals about their healthcare IT direction. How do you see that playing out?
Their direction is Paragon. The hospital I said that had a pretty good platform that we left in place is Meditech.
We belong to a consortium called AllSpire. That is us, Lehigh Valley, Lancaster General, Hackensack Medical Center. Of the seven members, four are already on full Epic.
We know the direction McKesson is going with Horizon. We’re going to have to make a decision in the next couple of years as to where we’re going to go. We know we’re not going to stay on Horizon.
My job is to try and give the organization options. When you take a look at what’s going on in healthcare and you start looking at the trajectory of hospital buy-ins, can you really justify a huge expense?
Nobody goes ambulatory Epic unless they’re going inpatient as well. Isn’t that predetermined?
I don’t know. I’m not really sure. Before we did this, I talked to a number of consulting companies. How much cross do you have between the people that come into your ambulatory and are in the hospital? How much back and forth do you really need? Could that be done by a summary of care, CCD, and CCDA? I’m not sure — that might be.
We’ve got a direction we could take, where we have like-for-like licenses because of all the investment we’ve made over lots of years. We’ve got an option for an integrated platform that already exists in one of environments — it might be something we want to do. We’ve got a third option that we’ve already got the ambulatory component in, and then if we wanted to work with our partners in our coalition, we could do that. What I’ve tried to do is try to give Atlantic Health multiple options to choose from.
What do you think the driver will be as to which way they go?
I think it will be looking at where we are from a volume perspective, where we want to be on the risk side, how much we want to manage what we have.
We’ve got two accountable care organizations. If we do a good job in that realm, aren’t we going to be driving patients out of our own hospitals? If we do that, we want a really, really robust ambulatory system along with population health management, analytics, and care management tools. How big does the hospital system really now have to be?
Have you looked at any of those technologies for ACOs, population health management, and analytics?
No. We stepped in gingerly. We took our time. We tried to use what we had in place.
We started off with RelayHealth. We’ve been a big user of RelayHealth for many years. RelayHealth provides the platform for our regional health information exchange. We’ve got 30 hospitals on that here. We started off with that, and then we moved into some business intelligence. We have MedVentive for population and risk management. McKesson does a lot of work in the payer space for disease management, so we’re working with them right now on putting in their care coordination tool.
We spent a little time understanding what it is we needed to do, then tried to put a few technologies in to be able to do that. We’ve got the business intelligence. We’ve got to work on the care coordination tool — that’s next. We’ve got Relay to do some of the health information exchange.
We use Imprivata Cortext, a secure texting tool. We’ve built specific directories for the ACO physicians so that they can now use that as a secure referral tool for each other.
I’ve been a customer of Imprivata in multiple organizations. They’re an easy company to do business with. I’ve used their OneSign. Our doctors love the tap-and-go because they all have their little card and their one workstation. They don’t even log off, they just tap. It closes the screen and they tap it again wherever they go — it brings up their session wherever they are. They just love that. We started using their secure texting about a year ago.
They’re using Imprivata Cortext it as their communications clearinghouse so they don’t have to play phone tag? They just send the text message and walk away?
That’s right. Our ACO put together a per-member, per-month incentive for physicians up front so the physicians don’t have to wait until savings at the end of the year. There’s a number of different sections there. There’s one for the use of technology. If they use RelayHealth, if they use Imprivata Cortext, if they automate their offices, they get a certain amount of money. For some process measures, they get it. For some outcomes, they get it. There’s a couple of other things. Their whole per-member per-month incentive is based on certain activities that they do.
I assume you need to analyze your data across the Epic on outpatient and McKesson and Meditech on inpatient. What are using for a data warehouse?
We use Horizon Performance Manager. The pop stuff all comes out of MedVentive. MedVentive has data from the EMRs, from the HIE, and whatever they might need from the hospital.
Are you looking at any technologies that can help support the clinician-patient relationship and patient engagement?
Our app is a patient-facing app. We’re constantly working on we help physicians and patients communicate.
A number of years ago, we put in RelayHealth, which had secure messaging with physicians. I had one doctor say to me, “ I will never, ever, ever, ever trade an email with a patient.” Then about a year ago, she came back and she said, “That’s not so bad.” She was telling another doctor, too, “I talk to my patients on email all the time.” It’s really interesting to see the dynamics. I think we’re probably going to be looking at doing something very similar on the mobile front.
Tell me about the mobile app.
It’s called Be Well. We have one for each one of our hospitals, because our physicians are more specific to our geographic area. It’s got a physician directory, ED wait times, and a whole bunch of different health trackers, including a way to download your Fitbit information.
Did you develop that yourself or have it developed?
We worked with a company called Axial Exchange. Everybody today will tell you that it doesn’t make any sense to go out and do that kind of work yourself when there’s just so many other companies that you can work with.
There’s a health encyclopedia in there, but it’s the same kind of health encyclopedia we use on our website. For us, now we’re migrating from the web to mobile. That’s where we’re going there.
As a nurse, do you think nurses are underserved as far as technology that helps them do their clinical role rather than just documenting so that somebody else can send a bill or have the doctor read their notes?
That’s an interesting question. We put in Vocera a lot of years ago now. One of nurses’ biggest issues was the phone tag that they were playing with doctors. They don’t all carry around organizationally-provided smartphones. From an access to information, it could be more helpful if they did.
Do you discourage them from using their own?
We don’t. We do discourage them from SMS texting on their own. It is one of the reasons why we went out and got Cortext. Just telling people not to use SMS text and not giving them something to use makes no sense. It’s like spitting in the wind.
The interesting thing about nurses is that we’ve got those computers on wheels. They’re on those things all the time. To take them off takes them out of their work flow. The Cortext component has a PC-based user interface, not just mobile. You can be on the COWs or you can be on the mobile.
Right now for nursing, I think it’s moving in that direction. I just don’t think that it’s quite as mobile-enabled as some of the physician tools right now.
What are the organization’s biggest strategic issues that need IT help?
Care coordination is huge. We’re kind of schizophrenic because we still are fee-for-service and we still are doing procedures and patient care in the hospitals, but we also have these ACOs. While we still need to be able to get people in and have great turnaround time, decrease the length of stay, get more turns in as much as we can, on the other side, we’re still working on how do we keep people out of the hospital and in the ACO and keep and have that gap and address all the gaps in care and the transitions of care?
It’s like two different initiatives that we’re working on. We still have to keep the whole patient engagement and satisfaction thing going on the other side.
One of the things we did a few years ago –it’s on paper and we’re just getting ready to take a look at how to automate it — is we had created a patient itinerary report. One of the big things that patients always complain about is that they don’t know what’s going to happen to them during the day. We created a report that pulled it from different parts of our technology — what’s the patient’s name, why are you here, when did you get here, who are the care providers on your case, what medications are you on, what labs did you have ordered for you, what were the results of the labs that you had yesterday, are you going for any other tests? Then there’s a little spot for “questions to ask my doctor.” That really was pretty popular and the patients seemed to like that. We’re probably going to automate that.
One of our next ventures in the mobile space is probably a bedside app that would give you that whole access to “my care team, my itinerary, my meds.” We also have that on our TVs right now, but we’ll look at putting it on an iPad.
Most hospitals would use an interactive patient system approach and put it on the TV, but you’re going to give patients iPads. Has anyone done that?
No. There’s a couple of places that are looking into doing it. There’s also a company out there called PadInMotion. They do some of that and they also give patients access to like Netflix and things like that on the iPad.
The more of this education stuff that you’re going to put in front of patients, a TV on a foot wall is really a tough user interface to give patients unless the thing is like 120 inches. I don’t know how big the screen has to be. Giving them an iPad is probably a good way to do that, but again, we also have to take a look at the patient population. When my dad was in the hospital, he could barely work the remote control on the TV, much less an iPad. It’s just trying to meet the needs of the patients that are there. You have to have multiple user interfaces to help patients through all the technology we throw at them.
Physicians are moving, or moving back, into leadership roles in health systems. What advice would you offer nurses who want to move into leadership roles outside of nursing?
Don’t say no to anything. I have a job today that practically didn’t exist when I first started in my nursing career. Take on any opportunity.
The one thing that sometimes you see with nurses is that they like to have things that are very concrete. It’s interesting because we work on the fly every day. We are the leaders of multitasking. But sometimes I think having a job that doesn’t have a very concrete job description or isn’t very clear on the time or the hours or the responsibilities — I think they shy away. They don’t realize how freeing a job that’s maybe not quite baked can be, because you can bake it yourself.
Nursing is also very isolating because you’re in those nursing units all the time. Sometimes you don’t get a lot of opportunity to meet and speak to board members, meet and speak to senior leadership. You’re just tucked away enough that you’re not exposed. That’s the other thing–say yes to any committee. Get out of the nursing unit and get some exposure.
Do you have any final thoughts?
For anybody who’s in a hospital and just thinks of healthcare as a hospital, where we are going should be frightening to you. We’re not going to be a hospital, especially if we start taking a look at the people who are going to disrupt us the most — retail medicine.
We have to start thinking about ourselves as the providers of retail medicine. We have to think about fast access, customer service, the customer’s always right — those things that you’ve traditionally heard about retail environments. We have to stop thinking about healthcare as a civil servant-type environment where you call and you get an appointment four weeks later. It’s going to change everything we do. We’re going to have to get faster, better, and more consumer friendly very quickly.